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Increased cleft width during knee flexion is useful for the diagnosis of medial meniscus posterior root tears

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aimed to evaluate changes in the cleft width, defined as the distance between the lateral edge of the medial tibial plateau and that of the medial meniscus (MM) posterior root, using open magnetic resonance imaging (MRI) in patients with MM posterior root tear (MMPRT).

Methods

This study included 25 patients (20 women and 5 men; mean age: 65.2 years) who were diagnosed with MMPRT and underwent pullout repair. Upon coronal imaging, the cleft width was evaluated at the 10° and 90° flexed knee positions. The difference in the cleft width (defined as the cleft width at 90° minus the cleft width at 10°) was also calculated. Upon sagittal imaging, the MM posterior extrusion (MMPE) at 90° was also evaluated. Separate univariate linear regression models were used to determine the association between the time from injury to MRI and radiographic measurements.

Results

The mean cleft width at 10° and 90° was 4.9 ± 2.6 mm and 7.4 ± 3.7 mm, respectively; the mean difference in cleft width was 2.5 ± 1.5 mm, and the mean MMPE at 90° was 3.7 ± 1.3 mm. There was a significant difference in cleft width at 10° and 90° (p < 0.001). The time from injury to MRI was significantly associated with the cleft width at 10° (R = 0.42; p = 0.023), cleft width at 90° (R = 0.59; p = 0.002), the difference in the cleft width (R = 0.62; p = 0.008), and MMPE at 90° (R = 0.53; p = 0.008).

Conclusion

This study demonstrates that the cleft width is significantly larger during knee flexion than during knee extension. Increased cleft width during knee flexion (“graben” sign) may help diagnose MMPRT, especially in cases where the cleft sign is unclear during knee extension.

Level of evidence

III.

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Abbreviations

MM:

Medial meniscus

MRI:

Magnetic resonance imaging

MMPRT:

Medial meniscus posterior root tear

MMPE:

Medial meniscus posterior extrusion

OA:

Osteoarthritis

MTP:

Medial tibial plateau

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Acknowledgements

We would like to thank Editage (http://www.editage.jp) for English language editing.

Funding

No funding was received for the support of this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan

    Takaaki Hiranaka, Takayuki Furumatsu, Shinichi Miyazawa, Keisuke Kintaka, Naohiro Higashihara, Masanori Tamura, Ximing Zhang, Haowei Xue & Toshifumi Ozaki

  2. Department of Orthopaedic Surgery, Ako Central Hospital, 52-6 Sohmon-cho, Ako, Hyogo, 678-0241, Japan

    Takaaki Hiranaka

Authors
  1. Takaaki Hiranaka
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  2. Takayuki Furumatsu
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  3. Shinichi Miyazawa
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  4. Keisuke Kintaka
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  5. Naohiro Higashihara
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  6. Masanori Tamura
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  7. Ximing Zhang
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  8. Haowei Xue
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  9. Toshifumi Ozaki
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Contributions

TF designed the study. TH and KK contributed to the analysis and interpretation of data. All authors contributed to data collection and interpretation and critically reviewed the manuscript.

Corresponding author

Correspondence to Takayuki Furumatsu.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board of Okayama University (approval no. 1857).

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Written informed consent was obtained from all study participants.

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Hiranaka, T., Furumatsu, T., Miyazawa, S. et al. Increased cleft width during knee flexion is useful for the diagnosis of medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc 30, 3726–3732 (2022). https://doi.org/10.1007/s00167-022-06983-8

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  • DOI: https://doi.org/10.1007/s00167-022-06983-8

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